CPT code 42104: Palatal excision, without closure2026 Medicare rate & RVUs in Tennessee

In Tennessee, Medicare pays $200.85 for 42104 in the office and $113.71 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 42104 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42104 covers

A surgeon removes a lesion from the roof of the mouth or uvula without closing the excision site. The service may be performed by an otolaryngologist or oral and maxillofacial surgeon in an office, ambulatory surgery center, or hospital. It represents removal of the lesion, rather than sampling tissue solely to establish a diagnosis or destroying the lesion in place.

Select this code when the operative report supports excision without closure; document the lesion’s location and the work performed. A 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Tennessee compares for 42104

Across 109 of 109 payment localities, the office rate for 42104 runs from $192.88 in Arkansas to $290.04 in San Benito County, CA. Tennessee pays $200.85. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42104 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 42104 in every payment locality

How the 42104 rate is calculated

Each of 42104’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 42104

42104 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 42104

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 42104 has changed in Tennessee

Price 42104 for an earlier date of service

Where the Tennessee rate applies

Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.

• Adams
• Adamsville
• Alamo
• Alcoa
• Alexandria
• Algood
• Allardt
• Altamont

Browse all communities in Tennessee

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates